2022, Myocardial Infarction and Plaque

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Thus, it has recently become generally accepted that most plaque ruptures resulting in myocardial infarction occur in plaques that narrow the lumen diameter by 40% of the arterial cross section may be involved by plaque. Fig 1 shows typical examples of two such plaques.

Ischemia

Ischemia Plaque Stenosis Myocardial Infarction

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J. 2000;139:430–436. Am J Cardiol.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. MINOCA I do not have the bandwidth here to write a review of MINOCA.

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m.

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

Circulation

NOVEMBER 11, 2024

Background:The no-reflow has been reported to be associated with larger infarct size and mortality after acute myocardial infarction (AMI). The incidence of no-reflow was higher in patients with attenuated plaque ≥5 mm in length as evaluated by intravascular ultrasound (IVUS).Objective:The vs. 8.6%, p < 0.001).

Ultrasound

Ultrasound Plaque Blood Pressure Myocardial Infarction

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

J Electrocardiol [Internet] 2022;Available from: [link] Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%) V Fib Cardiac arrest Prolonged QTC NSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different) Moderate single-vessel CAD. An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!!

Plaque

Plaque Chest Pain Thrombosis Stenosis

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

Therefore it means acute type 1 ACS plaque rupture with impeded flow and impending full occlusion until proven otherwise. A New ST-segment elevation myocardial infarction equivalent pattern? Published 2022 Feb 20. 2022;Available from: [link] 7. Eur J Emerg Med. 2017;24:236–242. Am J Emerg Med. 2014;32:e5–e8.

Chest Pain

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction

A new paper by me – please share widely

Dr. Malcolm Kendrick

AUGUST 26, 2022

26th August 2022 And so, after a great deal of faffing about, my article on cardiovascular disease ‘Assessing cardiovascular disease: looking beyond cholesterol’ has been made free to view. A study in JAMA in 2022 suggested that ‘the absolute benefits of statins are modest and may not be strongly mediated through the degree of LDL reduction’.

Cardiovascular Disease

Cardiovascular Disease Cholesterol Article Plaque

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. Here is the abstract: Background Identification of ST elevation myocardial infarction (STEMI) is critical because early reperfusion can save myocardium and increase survival.

Ischemia

Ischemia STEMI Stenosis Chest Pain

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Dr. Smith's ECG Blog

MAY 10, 2023

ng/mL This single initial troponin at this level, in the context of chest pain, is high enough to be diagnostic of acute myocardial infarction. LAD plaque with 0-25 percent stenosis. I do not have her previous ECGs, but reportedly these T-wave inversions were not present previously. Her initial cTnI returned at 0.25

Coronary Angiogram

Coronary Angiogram Chest Pain Stenosis STEMI

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Dr. Smith's ECG Blog

APRIL 8, 2022

The ECG is diagnostic for acute transmural infarction of the anterior and lateral walls, with LAD OMI being the most likely cause (which has various potential etiologies for the actual cause of the acute coronary artery occlusion, the most common of which is of course type 1 ACS, plaque rupture with thrombotic occlusion).

Chest Pain

Chest Pain SCAD STEMI Blog

You Are Being Lied To About Cholesterol & Heart Disease.

Dr. Paddy Barrett

FEBRUARY 14, 2025

A heart attack is when that plaque ruptures and stops blood flow down the artery. This graph shows the absolute and relative risk reduction for statin therapy in preventing heart attacks (Myocardial Infarction), strokes and preventing death from any cause (All-cause mortality) 2. 2022 Mar 14. J Am Heart Assoc.

Cholesterol

Cholesterol Heart Disease Heart Attack Heart attacks

Lumbar disc herniation is an independent predictor of plaque burden in the patients with unstable angina

Frontiers in Cardiovascular Medicine

FEBRUARY 8, 2024

Objective Assessing the impact of lumbar disc herniation (LDH) on the plaque burden of coronary atherosclerosis is our objective. Methods In this study, a total of 212 patients (age 46–80 years) with unstable angina (UA) who underwent coronary angiography (CAG) in our hospital from January 2018 to July 2022 due to UA were included.

Plaque

Plaque Angina Myocardial Infarction Risk Factors

7 Things You Can Do To Reduce Your Risk Even If You Already Have Heart Disease.

Dr. Paddy Barrett

APRIL 5, 2024

2 Trends and Predictors of Participation in Cardiac Rehabilitation Following Acute Myocardial Infarction: Data From the Behavioral Risk Factor Surveillance System. 7 Secondary prevention following myocardial infarction: a clinical update. 11 Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction.

Heart Disease

Heart Disease Coronary Artery Disease Heart Attack Heart attacks

Micro and Nanoplastics and Cardiovascular Events – Recent Study

All About Cardiovascular System and Disorders

MARCH 7, 2024

Detailed analysis of the excised carotid plaques were carried out with pyrolysis-gas chromatography-mass spectrometry, stable isotope analysis, and electron microscopy. Primary endpoint of the study was a composite of myocardial infarction, stroke, or death from any cause in those who had micro and nanoplastics in the carotid plaque.

Plaque

Plaque Myocardial Infarction Laboratory Cardiac Function

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

DAIC

JANUARY 23, 2024

Atherosclerotic cardiovascular disease (ASCVD), caused by plaque buildup in arterial walls, is one of the leading causes of disability and death worldwide.1,2 3 Patients with ASCVD are at a higher risk for major adverse cardiovascular events (MACE) including heart attack or myocardial infarction (MI), stroke, and cardiovascular (CV) death.4

Cardiovascular Disease

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease

The Advantages Of A CT Coronary Angiogram

Dr. Paddy Barrett

AUGUST 1, 2023

A CTCA provides much more anatomical detail and can identify advanced plaque often missed by CT Coronary Artery Calcium Score scans alone. There are 3 types of coronary atherosclerosis visible on CTCA: Calcified Plaque - Easily Identified on both CT CAC & CTCA scans. Subscribe now How Often Does A CT CAC Scan Miss Plaque?

Coronary Angiogram

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain

Wrong lessons in lipidology : Eradicating LDL is not our goal !

Dr. S. Venkatesan MD

JANUARY 8, 2024

While the total body seems to do little in determining cholesterol levels, what is more scientifically shocking is slope of the curve between blood LDL levels and plaque burden is rarely linear. Nat Cardiovasc Res 1 , 554–561 (2022). LDL is obviously a target against atherosclerosis. Mind you LDL constitutes.000025% Reference 1.Lib

Cholesterol

Cholesterol Atherosclerosis Plaque Physiology

Pay now (in the evening) or pay later with interest (in the middle of the night).

Dr. Smith's ECG Blog

MARCH 1, 2025

Note: the 2022 ACC Expert consensus Chest pain guidelines state that "posterior STEMI-Equivalent" is a sign of acute coronary occlusion. Smith : clearly diagnostic of posterior and high lateral OMI (ST depression V2-V4, with hyperacute T-wave in aVL and recriproal STD in inferior leads).

Chest Pain

Chest Pain STEMI Stents Stent

Is it possible that this patient with acute chest pain and this ECG does not need emergent intervention?

Dr. Smith's ECG Blog

MARCH 19, 2025

Influenza-like illness can also trigger plaque rupture. Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded culprit artery - a systemic review and meta-analysis. This means that, in the United States alone, of 500,000 NSTEMI, 170,000 do not get the care they deserve.

Chest Pain

Chest Pain STEMI Stents Stent

Acute Dyspnea in a Dialysis Patient. K is 6.3 mEq/L. Are ECG findings due to hyperkalemia, or even due to Type 2 MI?

Dr. Smith's ECG Blog

JANUARY 21, 2025

This was attributed to a "Type 2 MI", which is acute MI that is not due to ruptured plaque, but rather due to "supply demand oxygen mismatch". Most MINOCA is due to ruptured plaque with thrombus that lyses and does not leave behind a visible culprit. They made a final diagnosis of type II myocardial infarction.

Chest Pain

Chest Pain STEMI Tachycardia Myocardial Infarction

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

The authors describe a case with some features in common with our patient -- a stressful event followed by a stress cardiomyopathy/acute myocardial infarction overlap syndrome. Acute myocardial infarction: an uncommon complication of takotsubo cardiomyopathy. Mechanisms of plaque formation and rupture. SanzRuiz, R.,

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Cardiovascular Update

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Webinars

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

A new paper by me – please share widely

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

You Are Being Lied To About Cholesterol & Heart Disease.

Lumbar disc herniation is an independent predictor of plaque burden in the patients with unstable angina

7 Things You Can Do To Reduce Your Risk Even If You Already Have Heart Disease.

Micro and Nanoplastics and Cardiovascular Events – Recent Study

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

The Advantages Of A CT Coronary Angiogram

Wrong lessons in lipidology : Eradicating LDL is not our goal !

Pay now (in the evening) or pay later with interest (in the middle of the night).

Is it possible that this patient with acute chest pain and this ECG does not need emergent intervention?

Acute Dyspnea in a Dialysis Patient. K is 6.3 mEq/L. Are ECG findings due to hyperkalemia, or even due to Type 2 MI?

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

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